Fillable FINANCE DEPARTMENT BUSINESS TAX 11222 ACACIA PKWY GARDEN

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FINANCE DEPARTMENT BUSINESS TAX 11222 ACACIA PKWY GARDEN

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2) CONFIRMATION INFORMATION:
Under federal and state law, compliance with disability access laws is a serious and significant responsibility that applies to all California
building owners and tenants with buildings open to the public. You may obtain information about your legal obligations and how to
comply with disability access laws at the following agencies: The Division of the State Architect at www.dgs.ca.gov/dsa/Home.aspx.
The Department of Rehabilitation at www.rehab.cahwnet.gov. The California Commission on Disability Access at www.ccda.ca.gov.
I hereby certify under penalty of perjury that I have read and understand the above statements, and that the
information provided above is true and correct to the best of my knowledge and ability.
Signature____________________________________________________ Date _______________________________
Printed Name ________________________________________________ Title _______________________________
1) BUSINESS INFORMATION:
Name of Business (DBA):_________________________________________________________________________
Name of Corporation or LLC: ______________________________________________________________________
Name of Owner(s), Partners, or Corporate Officer(s): ___________________________________________________
Business Start Date in Garden Grove: _____________________________________SIC Code: _________________
Physical Business Address: _______________________________________________________________________
Service of Process Address: _______________________________________________________________________
(Address where business has consented to receive official U.S. Mail)
Business Mailing Address: ________________________________________________________________________
(If different from the Service of Process Address)
Ownership Type Sole Owner LLC Corporation Partnership Number of Employees ________________
Social Security Number: ________________________ Federal Tax ID # ___________________________________
Driver’s License Number: _____________________________ ITIN or Other ID # _____________________________
Detailed Description of Business Activity: _____________________________________________________________
Business Phone: ________________________ Business Email: __________________________________________
(Will be public information) (Will be public information)
Seller’s Permit Number: ____________________________ NPDES / WDID # ________________________________
State Contractors License # ___________________ Class: _______________ Expiration Date: __________________
Job Address: _______________________________
General Contractor Sub-Contractor Sub List Provided
Other State License: __________________________________________ ABC License # ______________________
Number Type Exp. Date
FINANCE DEPARTMENT – BUSINESS TAX
11222 ACACIA PKWY GARDEN GROVE, CA 92840
PO BOX 3070 GARDEN GROVE, CA 92842
Phone (714) 741-5074 – www.ggcity.org
DATE STAMP
PPN# ______________
OFFICE USE ONLY: HB COMM OOC CTR RENTAL IND CTR FOOD TRUCK SVC PRVDR
SOS EN # ____________________________ SIC: ___________________ BT# ____________________________
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SECONDARY OWNER OR PRINCIPAL:
Owner or Principal _____________________________________________________ Title _____________________
Residence Address: _____________________________________________________________________________
Number Street Unit# City State Zip
Date of Birth _______________________________ Social Security # ______________________________________
Driver’s License# _____________________________ Cell Phone _________________________________________
Signature ______________________________________________________ Date ___________________________
3) SUPPLEMENTARY INFORMATION REQUIRED (INFORMATION IS NON-PUBLIC):
PRIMARY OWNER OR PRINCIPAL:
Owner or Principal _____________________________________________________ Title _____________________
Residence Address: _____________________________________________________________________________
Number Street Unit# City State Zip
Date of Birth _______________________________ Social Security # ______________________________________
Driver’s License# _____________________________ Cell Phone _________________________________________
Signature ______________________________________________________ Date ___________________________
4) CALCULATING BUSINESS LICENSE COST FOR INITIAL APPLICATION:
BASE TAX DUE $ 42.50
PENALTY (10% of base tax) $ _______
PROCESSING FEE $ 25.00
STATE ADA FEE $ 4.00
TOTAL DUE $ 71.50
VALIDATION
TAXES ARE DUE PRIOR COMMENCEMENT OF BUSINESS.
BUSINESS LICENSES ARE ANNUAL, ANNIVERSARY DATED.
RENEWALS ARE BASED ON GROSS RECEIPTS IN ARREARS PER
THE APPLICABLE TAX SCHEDULE FOR YOUR TYPE OF BUSINESS.
ZONING CLEARENCE AREA USE ONLY
YES NO INITIALS ____________ DATE________________
ZONE: _______________________________ SQ FT _________________
CONDITIONS: ________________________________________________
MOBILE VENDORS / FOOD TRUCKS ONLY
Products Sold ____________________________ Registered Owner of Vehicle ______________________________
Is Vehicle Subleased? YES NO VIN # ____________________________________________________
Make of Vehicle ___________________ Year _____________ License Plate # ______________________________
THE FOLLOWING DOCUMENTATION MUST ACCOMPANY BUSINESS LICENSE APPLICATION:
Legible copy of valid driver’s license for each driver Current DMV auto registration Proof of current auto insurance referencing VIN #
Color photos of vehicle showing full side profile with logo and full rear of vehicle with license plate
BUSINESS TAX OFFICE USE ONLY
BT# _____________________________________
NN# __________________ INITIALS ___________
AUDIT ___________________________________
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FINANCE DEPARTMENT BUSINESS TAX 11222 ACACIA PKWY GARDEN

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Completed 28 May 2021

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